All tumor necrosis factor (TNF) antagonists are associated with hepatotoxicity and thus induce liver injury, commonly manifested as hepatitis B virus and hepatitis C virus reactivation, acute hepatitis, drug-induced liver disease, cholestasis, serum liver enzyme activity elevation, and even acute liver failure. Hence, the application of TNF antagonists in hepatic disease treatment remains controversial. This review summarizes currently available data on the mechanism and application of TNF antagonists in hepatic disease treatment. Although TNF antagonists have been applied for many years, large randomized controlled trials are still recommended to assess its efficacy and safety and to achieve a consensus.

Objective To investigate the significance of "merge" model versus "traditional" model in rotation training for professional clinical postgraduate students in department of gastroenterology. Methods The professional clinical postgraduate students who underwent rotation training in Qingdao Municipal Hospital from July 2012 to July 2016 were enrolled as subjects and were trained with the"merge" model and the "traditional" model, respectively. The two groups of subjects were compared in terms of clinical knowledge , skills , and core competencies . Results The postgraduates trained by the"merge" model had a significantly higher total score of clinical examinations than those trained by the"traditional" model [(92.60±2.52) vs. (83.80±3.14), t=10.93, P<0.01], while there were no significant differences in professional quality and doctor-patient communication between the two groups. Compared with those trained with the"traditional"model, the postgraduates trained by the"merge"model had significantly better understanding of clinical knowledge and clinical thinking ability, diagnosis and treatment skills, and psychological quality (χ2=27.00, 10.23, and 12.21, all P<0.01);however, there was no significant difference in clinical research ability between the two groups (χ2=1.39, P=0.24). Conclusion The model of professional clinical postgraduate training combined with standardized training of residents is superior to the traditional training model, and compared with the "traditional" model, the "merge" model is more beneficial to the training of comprehensive clinical practice abilities and thus holds promise for further application.

Objective:To evaluate the application of digital memory in abdominal physical examination teaching in cultivating gastroenterology professional postgraduates during the course of clinical rotations.Methods:Sixty clinical specialty postgraduates from Qingdao Municipal Hospital practicing in gastroenterology department from September, 2016 to September, 2018 were selected as subjects, and were randomized into experimental group ( n=30) and control group ( n=30). They were respectively received digital memory mode and traditional mode for clinical practice. The teaching effect was evaluated by comparing the scores of theory examination, skill results and clinical assessment at the end of training stage. Statistical analysis was performed using t test and chi-square test by SPSS 17.0. Results:There was no significant difference in the scores of theory examination and skill operation results between the experimental group and the control group, however, the number of excellent postgraduates and the average scores in clinical assessment were significantly higher than those in control group ( χ2=9.14, P=0.01). Questionnaire survey showed good evaluation of digital memory model in the experimental group. The recognition rate of learning interest and initiative, theoretical knowledge, systematic memory, clinical thinking ability as well as operational skills are 56.67%, 63.33%, 66.67%, 63.33% respectively. Conclusion:The digital memory mode in abdominal physical examination teaching demonstrates good effects on cultivating professional postgraduates' clinical comprehensive ability during the course of rotation in gastroenterology department, which worth further popularization.

Sixty general practitioners of in-service training undertaking rotation in gastroenterology department of Qingdao Municipal Hospital from July 2017 to July 2019 were randomized assigned in trial group ( n=30) and control group ( n=30). The problem-oriented mode was applied in trial group and conventional mode was applied in control group for teaching of two typical digestive diseases (upper gastrointestinal bleeding and acute pancreatitis). The formative evaluation and questionnaire survey were used to compare the teaching effects and the results of evaluation were compared with χ 2 test by SPSS 17.0 between two groups. The excellent and good rates of evaluation for the clinical psychological quality, clinical reasoning ability, doctor-patient communication ability and practice-based learning and improvement ability in trial group were significantly higher than those in the control group(χ2=7.38, P=0.03; χ2=12.96, P<0.01; χ2=23.33, P<0.01; χ2=16.14, P<0.01). Questionnaire survey showed more satisfaction towards teaching method in trial group was higher than that in control group(χ2=12.86, P<0.01); and the clinical reasoning ability, learning initiative and self-confidence in trial group were improved more markedly than those in control group(χ2=8.26, P=0.02; χ2=19.48, P<0.01; χ2=21.46, P<0.01). The problem-oriented clinical thinking teaching model demonstrates good effects on clinical comprehensive ability for general practitioners of in-service training during gastroenterology rotation, which is worth further promotion.