Clinical skills training center of Dongyang People's hospital introduced lean man-agement conception into the resident clinical skills training. The recruited residents were grouped by degree, the training contents were detailed, and teaching plans were normalized, and small class teach-ing and real-time feedback were implemented, which improved the normalization and standardization of resident training. The implementation of lean management leads to great progress in resident train-ing, but still needs further efforts. Only in the long-term management of standardization, can lean man-agement conception be embedded in daily work, making clinical skills training center play its role in cultivating medical talents effectively.

Objective To explore the relationship between sex hormone-binding globulin (SHBG) of gestational diabetes mellitus ( GDM ) pregnant women with well-controlled glucose and pregnancy outcomes. Methods Two hundred and fifty-one GDM pregnant women of 24 - 28 weeks in Shengjing Hospital of China Medical University were recruited from Mar. 2005 to Mar. 2010. Two hundred and sixteen cases of GDM with well-controlled glucose were defined as glycemic satisfied group, and they were treated by diet therapy ( 169 cases) or insulin therapy (47 cases) . Thirty-five cases with unsatisfied glucose were defined as glycemic unsatisfied group. One hundred and ninety-two healthy pregnant women of 24 - 28 weeks were defined as healthy control group. Serum SHBG and homeostasis model analysis of insulin resistance ( HOMA-IR) at 24 - 28 weeks and above 36 weeks were measured. GDM was diagnosed bytwo-step method according to the National Diabetes Data Group ( NDDG) criteria. The pregnancy outcomes and complications of the three groups were recorded. Results ( 1 ) Comparison of pregnancy outcomes and complications: glycemic satisfied group was less likely to develop hypertensive disorders in pregnancy ( 10. 6% ) , premature birth(8. 3% ) ,large for gestational age ( LGA) (8. 8% ) , neonatal asphyxia(3. 7% ) and neonatal hypoglycemia ( 2. 3% ) compared to glycemic unsatisfied group ( 42. 9% , 34. 3% , 31. 4% , 22. 9% and 11. 4% ,respectively). And the difference was statistically significant (P ＜0. 05 or P ＜0. 01). There was no significant difference for incidence of polyhydramnios, pueperal infection, postpartum hemorrhage, neonatal hyperbilirubinemia between the two groups ( P＞ 0. 05 ) . When compared to healthy control group(7. 3% ,2. 1% ,4. 2% ,2. 1% and 1. 6% ) ,no significant difference was found for incidence of premature birth( 8. 3% ) , pueperal infection ( 3. 2% ) , postpartum hemorrhage (5. 1% ) , neonatal asphyxia (3. 7% )and neonatal hypoglycemia(2. 3% ,P ＞0. 05). (2) Comparison of results of 24 - 28 weeks and above 36 weeks: serum SHBG of glycemic satisfied group [( 384 ± 88 ) , (457 ± 48 ) nmol/L]was significantly higher than that of glycemic unsatisfied group[(313 ±45) ,(401 ±73) nmol/L];HOMA-IR of glycemic satisfied group (5. 3 ±1.1,5.5 ±1.1) was significantly lower than that of glycemic unsatisfied group (7. 0 ± 1. 3 ,7. 6 ± 1. 7 ; P ＜ 0. 01). Serum SHBG of glycemic satisfied group was significantly lower than that of healthy control group [( 492 ± 95 ) , (565 ± 40 ) nmol/L]; and HOMA-IR of glycemic satisfied group(5. 3 ± 1. 1,5. 5 ± 1. 1) was significantly higher than that of healthy control group (3. 6 ±0. 6,3. 9 ± 0. 5 ;P ＜ 0. 01 ) . FPG of glycemic satisfied group [( 5. 84 ± 0. 28 ) , ( 5. 16 ± 0. 13 ) mmol/L]was significantly lower than that of glycemic unsatisfied group [(6. 13 ± 0. 16 ) , ( 5. 68 ± 1. 14) mmol/L; P ＜ 0. 01]. FINS of glycemic satisfied group [( 20. 4 ± 2. 1 ) , ( 24. 1 ± 4. 2 ) mmol/L]was significantly lower than that of glycemic unsatisfied group [(24. 7 ± 4. 5 ) , ( 29. 9 ± 2. 7 ) mmol/L; P ＜ 0. 01]. ( 3 ) Correlation analysis. Between 24 - 28 weeks, SHBG was negatively correlated with HOMA-IR in the three groups ( r = -0. 952, P ＜0. 01) ; and SHBG was negatively correlated with HOMA-IR in glycemic satisfied group ( r = -0. 903, P ＜0. 01). Conclusions Well-controlled glucose can not completely improve maternal and fetal outcomes of GDM pregnant women. High insulin resistance and low serum SHBG can influence pregnancy outcomes.

Objective To detect the DMD gene mutation sites and the regions of breakpoints in Duchenne/Becker muscular dystrophy (DMD/BMD) patients in northern China. Methods Multiplex amplifiable probe hybridization (MLPA) was used to detect the mutation in 59 cases (51 cases with DMD and 8 with BMD) from northern China and dystrophin gene mutations in their parents. Results From northern China and dystrophin gene mutations 59 families found gene deletions in 33 cases of 59 DMD/BMD patients (55.9%), duplications in 6 cases (10. 2%) and point mutation in one case (1.7%). Intron 44 was most frequently affected (n = 13, 33.3%), followed by intron 50 (n = 11, 28.2%) and intron 45 (n=8, 20.5%). The novel mutations were identified, in two patients including two independent duplications carried by patient D1 149 and a point mutation [5208del(A)] carried by patient D1 65, which were not included in Leiden database. In addition, an exon 22 deletion was found in one patient, which was the first reported case in Chinese patients. Conclusions Deletions are mostly located in the hotspot between exon 45 and 50. Duplications mostly occurred in the 5' end of the gene. Intron 44 is the most frequently affected breakpoint in northern Chinese population.

OBJECTIVETo explore the relationship between the prevalence of Candida albicans and early childhood caries(ECC) among 3-5 years old children of Uygur and Han nationalities in Kashi city, Xinjiang province.

METHODSTotally 397 generally healthy children(Uyghurs 256, Hans141) aged 3-5 years were recruited randomly in Kashi city using the stratified cluster random method. Dental plaque samples were collected from carious tooth tissues of children with ECC and from supragingival tooth sites of caries free(CF) children, respectively. Plaque samples were cultured and Candida albicans were isolated selectively by using CHROM agar candida medium. The isolates were further identified using methods of germ tubes test, Gram stain and PCR molecular biology. The data were analyzed using Pearson χ(2) test and Spearman analysis.

RESULTSThe prevalenses of Candida albicans were 44.5% (114/256) in Han children and 31.2%(44/141) in Urgur children, respectively(P=0.009). Candida albicans could be isolated from 48.8% (124/254) of ECC children, while 23.8% (34/143) of CF ones(P=0.000). The frequencies of Candida albicans acquisition of boys and girls of Uygur children were 51.2%(66/129) and 37.8%(48/127), respectively (P=0.031). The frequencies of Candida albicans acquisition increased with the decayed missing filled tooth (dmft) scores. For both Uygur and Hanchildren, the detection rates of Candida albicans were correlated with dmft scores(Uygur r=0.350, P=0.001; Han r=0.276, P=0.000).

CONCLUSIONSThe oral Candida albicans distributions were different in Uygur and Han ethnic groups. There were significant correlations between the presence of Candida albicans and ECC severityas well as score of dmft. There was a difference of the Candida albicans distributions between boys and girls among Uygur children. Candida albicans might be one of the important cariogenic microorganisms in ECC.

Candida albicans ; isolation & purification ; Candidiasis ; epidemiology ; Child, Preschool ; China ; epidemiology ; Dental Care ; Dental Caries ; epidemiology ; microbiology ; Dental Plaque ; epidemiology ; microbiology ; Ethnic Groups ; statistics & numerical data ; Female ; Humans ; Male ; Prevalence

Objective:To explore the clinical characteristics, treatment regimens and prognostic influencing factors of patients with multiple myeloma (MM) involving central nervous system (CNS).Methods:The clinical data of 18 MM patients involving CNS in Second Affiliated Hospital of Naval Medical University from January 2014 to June 2020 were retrospectively analyzed. Their clinical characteristics, treatment and prognosis were also analyzed. Kaplan-Meier method was used to make survival analysis and log-rank was performed; Cox proportional risk model was used to make univariate and multivariate analysis.Results:The cohort of 18 patients included 12 males and 6 females; the median age of patients involving CNS was 54 years (38-71 years). The median time from diagnosis to the involvement of CNS was 22 months (0-126 months).Among 18 patients, 1 case was primary MM involving CNS, and 17 cases were secondary MM involving CNS. All patients had Durie-Salmon (DS) stage Ⅲ; 10 cases had international staging system (ISS) stage Ⅲ, 6 cases had ISS stage Ⅱ, and 2 cases had ISS stage Ⅰ. Involvement sites of CNS included 7 cases of involving the dura mater alone and 4 cases of involving the pia mater alone, 2 cases of involving brain parenchyma and 5 cases of involving both meninges and brain parenchyma. The most common neurological symptoms were headache and cranial nerve palsy, and 9 patients had multiple neurological symptoms. All patients received systemic therapy, 16 patients received an intrathecal injection and/or radiotherapy; and the overall effective rate was 66.7%, including 3 achieving strict complete remission (sCR), 1 achieving complete remission (CR), 3 achieving very good partial remission (VGPR), 5 achieving partial remission (PR). The median overall survival (OS) was 32.7 months. Counting from the point of CNS involvement, the median progression-free survival (PFS) and OS time was 7.5 months, 12.2 months, respectively. The median PFS of MM patients in the dura-involved alone group was longer than that in the non-dura-involved alone group (15.1 months vs. 5.9 months, P = 0.009); the median OS of MM patients in the dura-involved alone group was longer than that in the non-dura-involved alone group (16.9 months vs. 10.7 months, P = 0.175). Multivariate Cox analysis showed that dura mater involvement alone was an independent factor affecting PFS in MM patients with CNS involvement ( HR = 0.191,95% CI 0.038-0.952, P = 0.043). Conclusions:MM involving CNS is rarely found and has a very poor prognosis. Different sites of CNS involvement could affect the prognosis of patients. There is a lack of effective treatment regimens.

Objective:To investigate the efficacy and safety of daratumumab in relapsed and refractory multiple myeloma (RRMM) .Methods:The clinical characteristics, adverse reactions, efficacy, and prognosis of 46 patients with RRMM treated with daratumumab in Shanghai Changzheng Hospital from September 2017 to March 2020 were retrospectively analyzed.Results:All patients were treated with daratumumab-based regimen: 8 in the Dd group, 35 in the DRd group, and 3 in the DVd group. With a median follow-up of 9.6 months, the overall response rate (ORR) was 75% [complete remission (CR) rate 18.2% ] among the 44 patients available for evaluation. The ORRs of patients resistant to bortezomib, lenalidomide, and both were 70.6% , 69.2% , and 63.6% , respectively. The CR rates of patients resistant to bortezomib, lenalidomide, and both were 17.6% , 11.5% , and 13.6% , respectively. No significant difference was observed in ORR and CR rates among the three groups. The ORRs of the DRd, DVd, and Dd groups were 85.3% , 66.7% , and 28.6% , respectively ( P=0.007) . The median PFS of 46 patients was 8.9 months, the median OS was not reached, and the 1-year OS rate was 74% . The median PFS and OS in the DRd group were longer than those in the Dd group (PFS: 14.4 months vs 2.0 months; OS: not reached vs 5.2 months) . After treatment with daratumumab, neutropenia is the most common hematological adverse reaction above grade 3. Non-hematological adverse reactions are mainly infusion-related adverse reactions and infections. Prognostic analysis showed that patients with extramedullary invasion had shorter PFS and OS compard with patients without extramedullary invasion (PFS: 5.7 vs 14.4 months, P=0.033; OS: 6.3 months vs not reached, P=0.029) . The OS of patients with an ECOG score of 3-4 was significantly shorter than patients with an ECOG score of 1-2 (5.9 months vs not reached, P=0.004) . Conclusion:Daratumumab-based regimens have good efficacy and safety in the treatment of RRMM.

Objective: To study the detection rate of Streptococcus mutans in oral cavities of 3-5-year-old Han, Uygur and Mongolian children in Bortala Mongolian Autonomous Prefecture, and the correlation between genotype and dental caries of preschool children. Methods : Ninety children were randomly selected from the sample bank of children′s oral epidemiological survey data in the Bozhou area of Xinjiang. Forty-five children were included in the high caries group (more than 5 missing teeth), and 45 children were included in the noncaries group (0 missing teeth); each group comprised 15 children of each of the Han, Uygur and Mongolian nationalities. Plaque samples were collected and cultured with light saliva-bacillin agar medium and brain-heart infusion medium. Streptococcus mutans were cultured, and clinical isolates were further isolated and identified by Gram staining, biochemical identification and polymerase chain reaction. Genotype distribution was detected by random primer polymerase chain reaction. Results : The detection rate of Streptococcus mutans in the 90 included children was 75.5%. The detection rate of Streptococcus mutans in the high caries group was 86.7%, which was significantly higher than that in the caries-free group (64.4%) (P=0.014). There was no significant difference in the distribution of Streptococcus mutans among Han, Uygur and Mongolian nationalities (P=0.457). A total of 549 clinical strains of Streptococcus mutans were obtained, and 113 different genotypes were found. In the high caries group, 61.5% carried more than one genotype of Streptococcus mutans, and 37.9% of the caries-free group had more than one genotype. The genetic polymorphism of Streptococcus mutans in the high caries group was significantly higher than that in the caries-free group (P=0.035). Spearman correlation analysis showed that there was a positive correlation between oral Streptococcus mutans gene polymorphism and caries sensitivity (r=0.258, P=0.034). Conclusion The distribution of Streptococcus mutans in children′s oral cavity in the Bozhou area was different between the high caries group and the caries-free group, but there was no difference among nationalities. Streptococcus mutans in the high caries group had more genotypes than those in the caries-free group. The genetic polymorphism of Streptococcus mutans might be related to the caries-causing ability of Streptococcus mutans.

Objective To investigate the appropriate venous access for obese patients undergoing metabolic and bariatric surgery by comparing the clinical outcomes of different lengths of peripheral intravenous catheters.Methods Inpatients who underwent bariatric surgery in a tertiary hospital in Zhejiang from August 2022 to December 2022 were selected as the study population using a fixed-point continuous convenience sampling method.A stratified block randomisation method was used to divide the group into an experimental group 1(mini-midline catheters),an experimental group 2(midline catheters)and a control group(short peripheral intravenous catheters,Short PIVCs).The incidence of catheter-related complications,the rate of extubation due to complications,the duration of catheter retention,the time to first catheter-related complication were compared in the 3 groups.Results A total of 186 patients were included,with 62 patients in each group.The overall incidence of catheter-related complications in experimental group 1,experimental group 2,and control group were 25.81％,8.06％,and 58.06％.The extubation rates due to complications were 19.35％,4.84％,and 41.94％,and the duration of catheter retention was 7.00(6.00,7.00)d,7.00(6.00,7.00)d,6.00(3.00,6.25)d.The differences were statistically different(P＜0.05)when comparing the 3 groups.Among them,the differences in the overall incidence of catheter-related complications and the rate of extubation due to complications were statistically significant when comparing experimental group 1 with the control group,experimental group 2 with the control group,and experimental group 1 with experimental group 2(P＜0.017);the duration of catheter retention in both experimental group 1 and experimental group 2 were higher than it in the control group,and the differences were statistically different(P＜0.017).Conclusion The complication rate of mini-midline catheters and midline catheters is lower than that of short ones,and the indwelling time is consistent with the perioperative period of metabolic and bariatric surgery,which is suitable for use in patients undergoing metabolic and bariatric surgery.

Objective:To summarize the clinical characteristics and prognosis of 51 patients with Waldenstr?m’s macroglobulinemia (WM) and evaluate the efficacy and adverse reactions of ibrutinib in the treatment of WM.Methods:We carried out a single-center retrospective study, including 51 patients with WM of our single center from November 2008 to October 2019.Results:The median age at diagnosis was 65 years with a male-to-female ratio of 2.64∶1. There were 9 (18%) , 21 (41%) , and 21 (41%) ISSWM stage low-, intermediate- and high-risk patients identified, respectively. A total of 27 (73%) patients harbored MYD88 L265P mutation. The median follow-up time was 38.6 (0.3-120.0) months, the median progression free survival was 46.4 months, and the median overall survival was not reached. The overall remission and major remission rates of patients who received ibrutinib were 87% and 80%, respectively. The median time to achieve at least partial remission of patients treated with ibrutinib was 8 weeks, which was earlier than those treated with other drugs ( P<0.05) . Conclusion:WM is often seen in elderly men. MYD88 L265P had a high frequency in WM. The findings of our study validate the efficacy of ibrutinib monotherapy. Even in patients with advanced age and at high risk of ISSWM, the overall remission rate and major remission rate are high. Ibrutinib is a safe and effective therapy because of its rapid onset and rare serious adverse reactions.

Objective:To investigate the treatment options for multiple myeloma patients with central nervous system involvement (CNS-MM) , as well as their clinical characteristics and prognostic factors.Methods:Between January 2011 and January 2022 our center diagnosed 18 people with CNS-MM. A retrospective analysis was done on the clinical information from the initial diagnosis and central nervous system involvement, and it was compared to 1∶3 matched newly diagnosed MM from the same period. Analysis was done on the clinical characteristics and survival rates of the two groups.Results:In patients with CNS-MM, the median time of onset was 14.2 (0.9-79.6) months and the median overall survival (OS) was 30.5 months from initial diagnosis and only 3.8 months in patients after CNS involvement. The CNS-MM patients showed more IgD type ( P=0.010) , severer anemia ( P=0.014) , a higher proportion of bone marrow plasma cells ( P=0.013) , more extramedullary lesions ( P=0.001) , and increased lactic dehydrogenase (LDH) ( P=0.009) when compared to the control group. Lenalidomide or pomalidomide-based combinations had higher rates of hematology and CNS remission than bortezomib or daratumumab-based regimens (75.0% vs 16.7% , P=0.019) . Patients who received IMiD-based regimens and had 2 high-risk factors at initial diagnosis (high LDH and extramedullary lesions) had a significantly lower incidence of CNS-MM ( P=0.026) . At the initial diagnosis, LDH ( P=0.008, HR=7.319, 95% CI 1.663-32.219) and extramedullary lesions ( P=0.006, HR=8.054, 95% CI 1.828-35.486) were independent risk factors for the occurrence of CNS-MM. Conclusion:Patients with CNS-MM had a poor prognosis. Patients with high LDH or extramedullary lesions at the time of the initial diagnosis are more likely to have CNS-MM. The prognosis of this patient may be improved by immunoregulator-based therapy.