Clinical teaching supervision system exhibited several problems in the imple-mentation process such as the team of supervision being not reasonable enough and the connotation of supervision not extensive and not going far in depth enough and so on. Through the way of strengthening the team of the clinical teaching construction,expanding the connotation and improving the functions of supervision,we can construct a new effective supervision system for clinical school teaching.

Objective To investigate the application effect of the new trinity teaching mode of clinical practice,which combines bedside teaching,simulation teaching and web-based teaching to-gether. Methods Totally 375 students of clinical medicine,enrolled into Guangzhou Medical Univer-sity in 2006,were randomly divided into department I of clinical medicine (control group,188 stu-dents)and department II of clinical medicine (experimental group,187 students). The students of these two groups were taught respectively with the conventional bedside teaching mode and the trinity teaching mode. Then at the end of clinical practice,assessment results of comprehensive theory and clinical skill in the graduation exam were compared by t test (significance level α=0.05)using SPSS 17.0 software and the questionnaire results of students in experimental group were analyzed. Results There were statistical differences in comprehensive theory and clinical skill assessment scores between two groups(P<0.05). The questionnaire survey showed an approval rate of 92.73%(153/165)for trini-ty teaching mode. Conclusions Facing the shortage of clinical teaching resources,the trinity teach-ing mode is better than the simple bedside teaching mode. The trinity teaching mode can alleviate the pressure brought by the lack of clinical teaching resources at present,create more learning and prac-ticing opportunities for students,and improve the effects of clinical practice teaching.

OBJECTIVETo study the patterns of cervical lymph node metastasis of medullary thyroid carcinoma.

METHODSNinety-one patients with medullary thyroid carcinoma first treated between January 1999 and October 2014 were analyzed retrospectively. Of 91 patients, 39 cases presented with clinical negative node (cN0) and 52 cases with clinical positive node (cN+). Central compartment dissection was performed in all cases. Lateral neck dissection was performed in 52 cN+ cases (71 sides). All neck dissection specimens were obtained and analyzed for lymph node (LN) involvement with respect to neck levels. The distribution of LN with metastasis was studied in cN+ patients and the following factors were used to study the predictive value of central compartment LN metastasis: sex, age, family history, tumor size, bilateral tumor, multifocality of the tumor, extracapsular spread, and remote metastasis. Univariate analysis with the χ(2) test was used to analyze the statistical correlation between central compartment LN metastasis and other clinical factors. Multiple logistic regression analysis was used to identify the factors related to central compartment metastasis.

RESULTSNeck and bilateral neck metastasis rates were 73.6%, 19.8% respectively. Metastasis rates in central compartment and superior mediastinal region were 68.1% and 27.5% respectively. The central compartment metastasis rate was 33.3% in cN0 patients and 94.2% in cN+ patients. The superior mediastinal metastasis rate was 2.6% in cN0 patients and 46.2% in cN+ patients. Extracapsular spread was an independent predictive factor for central compartment metastasis (χ(2)=15.592, P=0.000, OR=12.876). The incidences of LN metastases at level II, III, IV, V were 62.9%,84.5%,83.1%,50.0% in cN+ patient, respectively. Multi-sites were involved. The possibility of lateral neck metastasis was higher when preoperative value of calcitonin was higher than 300 ng/L (66.7% vs 28.6%, χ(2)=5.771, P=0.016).

CONCLUSIONSCervical lymph node metastasis of medullary thyroid carcinoma is higher. Central compartment dissection is necessary in cN0 patients with extracapsular spread. Neck dissection from level II to level VII was necessary in cN+ patients. Preoperative value of calcitonin maybe can predict the lateral neck metastasis incidence.

Carcinoma ; Carcinoma, Neuroendocrine ; diagnosis ; pathology ; therapy ; Head and Neck Neoplasms ; diagnosis ; pathology ; therapy ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Mediastinal Neoplasms ; Neck ; Neck Dissection ; Retrospective Studies ; Thyroid Neoplasms ; diagnosis ; pathology ; therapy