Objective To screened out items with large proportion of technical analysis in obstetrics and gynecology physical examination by using statistical parameters Kappa index and to evaluate effect and clinical significance of Kappa index based on objective data and students' and teachers' subjective feeling.Methods We made Kappa index screening with double-blind method and established the Kappa index table for teachers and students.Students were randomly divided into conventional teaching group (n =26) and teaching reform group (n =29).Students in conventional teaching group traditionally followed the teacher to carry on the practice while those in teaching reform group received training according to the numerical value index and had examination after training.We paid attention to each student's weak points,provided personalized guidance and communicated with students actively.Results We found that it was uneasy for beginners to quickly grasp four step obstetrics palpation in-spection according to Kappa index.There were statistical differences in operation of gynecological physical examination between two groups (P =0.016).Conclusions Application of Kappa index can help us screen out skills in the operation suitable for training for eight-year program medical students.With quantitative evaluation,we can improve quality of clinical practice teaching in department of obstetrics and gynecology and guide educational reform.

Objective To investigate clinical features and extent of gastric, liver and pancreatic damage of primary Sjgren syndrome(pSS). Method Clinical data of 152 pSS patients with gastric,liver and pancreatic damage were analyzed.Results The occurence of chronic atrophic gastritis(CAG),the most commonly seen gastic involvment in pSS,was 77.8%.The atrophic leisions differed with patient's age.Compared with the control group, the atrophy and intestinal metaplasia of the pSS patients with CAG were milder(P

BACKGROUND:Sarcopenia is an age-related degenerative syndrome,and the relationship between mitochondrial autophagy and exercise in preventing and treating sarcopenia has been demonstrated.However,there is a lack of comprehensive reviews detailing the specific receptor proteins and signaling pathways involved in the role of exercise in sarcopenia prevention and treatment. OBJECTIVE:To comprehensively introduce the specific receptor proteins and signaling pathways related to mitochondrial autophagy and their role in the prevention and treatment of sarcopenia through exercise. METHODS:A literature search was conducted between February 1,2023,and April 1,2023,covering literature from database inception to April 2023.Databases included the Web of Science,PubMed,China National Knowledge Infrastructure(CNKI),WanFang Data,and VIP.Keywords used for the search included sarcopenia,muscle wasting,aging,elderly,mitochondria,mitochondrial function,proteins,pathways,and others.After strict inclusion and exclusion criteria,76 articles were ultimately included. RESULTS AND CONCLUSION:Sarcopenia is a disease characterized by a decline in muscle mass and function with age,and its pathogenesis involves neuro-muscular functional decline,chronic inflammation,acid-base imbalance,and mitochondrial dysfunction.Mitochondrial autophagy is an important process for clearing damaged mitochondria in cells,in which receptor proteins and signaling pathways are involved in the regulation of mitochondrial autophagy.Exercise can promote the occurrence of mitochondrial autophagy by regulating the activity of these receptor proteins and signaling pathways,thereby playing an important role in the prevention and treatment of sarcopenia.Exercise can induce mitochondrial autophagy in sarcopenia by upregulating AMPK,phosphorylating ULK1,and reducing mitochondrial energy,enhancing the expression of mitochondrial autophagy-related proteins associated with AMBRA1,and regulating the PINK1/Parkin pathway,to improve mitochondrial dysfunction caused by sarcopenia.In addition,exercise can activate the mTOR pathway to promote muscle growth and increase glucose uptake,thereby preventing and treating sarcopenia.Future studies are needed to further investigate the specific mechanisms and regulatory pathways of mitochondrial autophagy-related receptor proteins and signaling pathways in the prevention and treatment of sarcopenia by exercise,and to conduct more clinical trials in humans,thereby to promote further development in this field.

OBJECTIVETo evaluate the usage of Mayo staging system in Chinese patients with primary light chain (LC) amyloidosis.

METHODClinical data, treatment and outcome of 162 primary LC amyloidosis patients with Mayo Clinic staging in Peking Union Medical College Hospital from January 2009 to June 2015 were retrospectively analyzed.

RESULTSThe median age of 162 patients with Mayo Clinic 2004 stage was 57 (20-81) y, of them 62.3% were male. The number of patients with stage I to III were 44 (27.2%), 69 (42.6%), and 49 (30.2%), respectively. The median overall survival was not reached, 23 months and 12 months in patients with Mayo Clinic 2004 stage I, II, and III, respectively (P<0.001). Among 128 patients with Mayo Clinic 2012 stage, 48 patients (37.5%), 32 patients (25.0%), 32 patients (25.0%) and 16 patients (12.5%) were staged as Mayo Clinic 2012 stage 1 to 4, and the median OS was not reached, not reached, 13 months and 3 months, respectively (P<0.001).

CONCLUSIONMayo Clinic staging systems had important prognostic value in patients with primary LC amyloidosis.

Adult ; Aged ; Aged, 80 and over ; Amyloidosis ; diagnosis ; Female ; Humans ; Immunoglobulin Light-chain Amyloidosis ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Young Adult

Objective: To evaluate the clinical characteristics and outcomes of very high risk patients with primary immunoglobulin light-chain amyloidosis (pAL) at a single center in China. Method: Clinical data, treatment and outcome of 205 pAL patients in Peking Union Medical College Hospital from January 2009 to February 2016 were retrospectively analyzed. A 'very high risk’ group includes patients with Mayo 2004 stage Ⅲb and Mayo 2012 stage 4. Results: Of 205 patients, 34 (16.6%) were defined as very high risk pAL patients. The median age at diagnosis was 57 (20-84) years, and 22 patients (64.7%) were male. All 34 patients were diagnosed with cardiac involvement, multi-organ involvement was observed in 15 patients (44.1%) , and 27 (81.8%) had New York Heart Association Class Ⅲ or Ⅳ. Median values of serum cTnI, NT-proBNP, and free light chains difference were 0.25 μg/L, 11 733 ng/L, and 403 mg/L, respectively. Eight (24.2%) had more than 10% plasma cell on the bone marrow aspirate. Sixteen (47.1%) patients received bortezomib based chemotherapy and overall hematologic response rate was 58.3%. Median overall survival (OS) was 4 months. The estimated OS at 3, 6, 12, and 24 months was 51.3%, 44.0%, 35.2%, and 29.6%, respectively. Fourteen (41.2%) patients died within 3 months after the diagnosis. The estimated 1-year survival rate for the patients who got hematologic response, without hematologic response, and palliative treatment was 90.9%, 11.1%, and 0, respectively (P<0.001) . Conclusion Patients with very high risk pAL had very poor prognosis and the early death rate remained high. Those patients who obtained hematologic remission would have significantly better outcomes.

The correct thoughts and principles of diagnosis and treatment of chronic refractory wounds need to be formulated. Through the relevant domestic and international consensus and based on clinical experience, the Thoughts and principles of diagnosis and treatment of chronic refractory wounds in China is proposed. It is considered that in the diagnosis and treatment of chronic refractory wounds, in the case of fully understanding the patient′s medical history, the following thoughts and principles should be complied in order. (1) Pay attention to the cleanliness of the wound after being cleaned. (2) Reasonably perform debridement to avoid being " excessive" or " not thorough". (3) Reasonably perform examination, diagnosis, and differential diagnosis of pathogenic factors. (4) Treat according to etiology. (5) Find comorbidities and prevent adverse outcomes. (6) Select the correct wound treatment method reasonably and timely. When the conservative wound care treatment is considered, pay attention to embodying the concept of etiological treatment, treat the wound according to the principles of safety, phase, selectivity, and effectiveness, and make a reasonable choice of continuing conservative treatment or surgical treatment in time after completing the preparation of the wound bed. When surgical treatment is considered, pay attention to the selection of reasonable surgical method and donor site, pay attention to the healing rate of surgical wound site and the outcome of donor site, and give reasonable protection to the wound site after surgery. (7) Carry out rehabilitation treatment after wound healing and related health education.