We aroused students' learning interest,adjusted teaching contents,played the appropriate role of teachers,optimized teaching means and carried out comprehensive evaluation based on special characteristics of the optional course environmental eugenics and the knowledge structure of students to improve the teaching quality and teaching effect as well as make this course contribute to comprehensive ability of medical students.

Objective To explore the cause of acute myocardial ischemia early after coronary artery bapass graft (CABG) and surgical management on it. Methods From 2001 to 2009, 28 patients underwent urgent reoperation early after CABG due to acute myocardial ischemia. The incidence of reoperation is about 0.02%. The cause of reoperation inclouded early graft occlusion (10 cases) ,IMA damage or injury during harvesting(9 cases), inexactitude distal anastomosis(2 cases)and radial artery spasm(4 cases). The mean interval time between two operations was 8 hours. Reoperation was done under offpump bypass in 2 patients and on-bypass used in other patients. Unsatisfactoey graft were substituted with new graft material and thrombotic was removed. If LIMA was the reson for myocardial ischemia, an additional vein graft was inserted. The spasm radial artery were substituted with new vein graft. Completely revascularization was used in re-do CABG. Results Two patients died during reoperation. 8 patients was died between 1 day and 14 days after reoperation. IABP was used in 16 patients,which 2 patients received ECMO suppord and 2 patient received LVAD suppord at mean time. Conclusion There have very high mortality in acute myocardial ischemia early after CABG. The early diagnosis and correct surgical management can improve the rates of survival. The active prevent should be emphasized during the first CABG.

Objective To observe the effects of Xianfu Wenyang Tongluo Drink (XFWYTLD) on ANCA associated antigen in rats with thromboangiitis obliterans;To discuss its mechanism. Methods Totally 72 SPF male Wistar rats were randomized into sham-operation group, model group, Mailuoning Granule group and XFWYTLD low, medium, and high dose groups. Method of femoral artery injecting sodium laurate was used to duplicate models. From the second day after modeling, the rats in sham-operation group and model group were fed with distilled water, while other groups received gavage with relevant medicine. 15 days later, the activity of MPO in serum was detected through the method of ultraviolet spectrophotometry;the protein expressions of PR3 and LAMP-2 in femoral artery and the surrounding tissues were detected through the method of immunohistochemisty. Results Compared with sham-operation group, the activity of MPO in serum and the protein expressions of PR3 and LAMP-2 in rats of model group were significantly higher;Compared with model group, the activity of MPO in serum and the protein expressions of PR3 and LAMP-2 in rats of all medication administration groups decreased, among which the XFWYTLD medium dose group showed the most obvious decrease. Conclusion XFWYTLD may lower levels of ANCA associated antigen, and further inhibit humoral immune function.

Objective: To discuss the methods of treatment patients with aortic valve lesions associated with ascending aortic dilation. Methods: From 1996 to 2002, 32 patients were underwent Wheat procedure. The mean age of patients was (48 6?8 9) years. The pathology of aortic valve was bicuspid valve (19 cases,59%). The mean diameter of ascend aorta was (52 2?4 5) mm (45～60 mm). All patients received aortic valve and ascend aorta replacement. Results: All patients survived. The mean duration of follow up was 22 months. There was no postoperative death and no pseudoaneurysm. All patients were in NYHA class I～II after surgery. Conclusion: Wheat procedure is a simple and effective treatment for patients with ascending aorta dilation who need aortic valve replacement.

Objective To evaluate the changes of cerebral perfusion and hemodynamics in the patients with mono-carotid artery stenosis after stenting with the technique of DSA parametric imaging. Methods 15 patients with mono-carotid artery stenosis(the stenosis>75%) undergone carotid stenting were choosed. Digital subtraction imagines of diplo-carotid arteries were acquired before and after operation, then the imagines were processed by special soft ware in personal computer. The region of interest (ROI)were selected in the brain,internal carotid artery and superior sagittal sinus separately, the time-gray scale curves of the ROIs were drawn with the soft ware, from which,then acquired the following parameters from the time-gray scale curves,the largest gray values of brain in disordered side pre-and post-operation, and the parameters including peak value (PV), mean transit time (MTT) ,time to peak (TP), time of appearance to the peak , the max slope rate of the curve and relative time of cerebral circulation were also evalua-ted, respectively. The imaging speed was 7.5 pictures per second. The results were statistically evaluated by using matched-t test. Results Before the stenting, the values of the parameters peak value, the max slope rate of the curve,TP,MTT,relative time of cer-ebral circulation were 108.20±5.58 , 1.23±0.37 , (4.78±0.24)s , (8.20±0.42)s and(4.92±1.03)s , respectively; after the stenting , the values of the parameters above-mentioned were 114.20±7.58, 2.01±0.36, (4.14±0.40)s, (3.55±0.56)sand(4.18±0.89) s , respectively, the difference of the parame-ters above-mentioned pre-and post-operation were statisti-cally significant (t=5.97 , 8.00 , 0.21 , 10.21 , 10.12 and 4.14,P<0.05). Before and after operation, the values of time of appearance to the peak were (5.39±0.24) s and)(5.37±0.78) s , respectively , there was no statistical significance (t=0.21, P> 0.05). Conclusion DSA parametric imaging can be used to evaluate the changes of cerebral perfusion and hemodynamics before and after arterial stenting.

Objective:To analyze the influencing factors of the medical insurance balance of hospitalization expenses for gastric cancer surgery patients under DRG payment, for reference for promoting the reform of DRG payment in public hospitals and controlling hospitalization expenses reasonably.Methods:The gastric cancer patients enrolled in the gastroenterology department of a tertiary comprehensive hospital from January to July 2022 were selected as the research subjects. The indicators such as patient age, medical insurance balance, hospitalization expenses and their composition were extracted from the hospital information management system and the medical insurance settlement system a certain city. Descriptive analysis was conducted for all data, and stepwise multiple linear regression was used to analyze the influencing factors of patients′ medical insurance balance. Monte Carlo simulation method was used to simulate different combination scenarios of various influencing factors to analyze the probability of medical insurance balance.Results:A total of 205 patients were contained, including 117 in the medical insurance balance group and 88 in the loss group. The difference in hospitalization expenses and medical insurance balance between the two groups of patients were statistically significant ( P<0.05). The intervention of medical insurance specialists, correct DRG enrollment, parenteral nutrition preparation costs, anti infective drug costs, examination costs, and consumables costs were the influencing factors of patient medical insurance balance ( P<0.05). Through Monte Carlo simulation verification, patients with different cost parenteral nutrition preparations, or different anti infective drug schemes had the higher probability of medical insurance balance in the scenario where the medical insurance commissioner intervenes and the DRG enrollment was correct. Conclusions:The hospital adopted interventions from medical insurance specialists to ensure the correct DRG enrollment of patients, accurate use of parenteral nutrition and anti infective drugs, and reasonable control the cost of examinations and consumables, which could increase the probability of medical insurance balance for gastric cancer surgery patients. In the future, hospitals should further promote the procurement of drug consumables in bulk, reduce unnecessary examinations, develop standardized perioperative nutritional interventions and anti infection treatment pathways, ensure the accuracy of DRG enrollment, optimize clinical diagnosis and treatment pathways to improve the efficiency of medical insurance fund utilization and provide high-quality medical services for patients.

Objective:To analyze the clinicopathological features of giant ovarian masses(mean diameter≥10 cm)and analyze the clinical characteristics of patients in different age groups.Methods:The clinicopathological characteristics of 311 patients diagnosed with giant ovarian masses by surgery at Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University from January 2014 to December 2022 were retrospectively analyzed.Patients were further stratified by age and mass size to compare the differences of clinical and patho-logical features among different age groups and different mass diameter groups.Results:①The median age of thepatients were 44(24,60)years old.The first symptoms were as follows:ovarian mass discovered during physi-cal examination,abdominal pain,bloating,conscious abdominal distension,and symptoms of compression.②The surgical methods were as follows:unilateral oophorectomy(30.5％,95/311),ovarian cystectomy(28.9％,90/311),tumor staging or cytoreductive surgery(28.0％,87/311),total hysterectomy with bilateral adnexectomy(12.5％,39/311).③The pathological types were benign(49.5％,154/311),malignant(31.8％,99/311)and borderline(18.7％,58/311).④ Patients complained abdominal distension in＜20 years old group were signifi-cantly higher than the other two groups(P＜0.05).The ovarian resection rate in the＞50-year-old group was higher than that of the other two groups(P＜0.05),and the rate of unilateral ovarian resection in the＜20-year-old group was still as high as 30.1％(15/49).⑤ The size of the mass correlated with the duration of the disease.When the disease course was between 1 to 6 months,the mass diameter line＞30 cm was the most common(P＜0.05).The incidence of borderline tumors in the＞30 cm group was significantly higher than that in the other two groups,and the difference was statistically significant(P＜0.05).Conclusions:Ovarian mucinous and mucinous borderline tumors are the most common types of giant adnexal masses.The size of the mass tends to increase with the prolongation of the disease course.The incidence of borderline tumors increases with the in-crease of mass.Health education for young people should be strengthened.When abdominal pain,abdominal bloating,especially lower abdominal distension occurs,they should seek medical treatment in time to avoid adnex-ectomy due to borderline tumors.

OBJECTIVE: To evaluate the therapeutic methods and their effects on patients with cornual pregnancies.
 METHODS: A retrospective study was performed on 83 patients, who were diagnosed as cornual pregnancy at Drum Tower Hospital from June 2010 to April 2015. The patients were divided into 5 groups: a laparoscope group, angle resection and uterine repair guided by laparoscope (n=16); a surgery group, operated with angle resection and uterine repair (n=49); an abortion group, guided by ultrasound or laparoscope (n=6); a drug group, treated by methotrexate and mifepristone (n=8) and a pregnancy bursal puncture group (n=4). We compared the general conditions, surgery circumstances and average days in hospital among the laparoscope group, the surgery group, and the abortion group. Moreover, we also investigated the outcomes of the drug group and pregnancy bursal puncture group.
 RESULTS: Compared with the surgery group, the intraoperative blood loss in the laparoscope group and abortion group was less (P<0.05). The length of procedure and average days in hospital between the surgery group and the laparoscope group were not statistically significant (P>0.05). The length of procedure in the abortion group was less than that in the laparoscope group or the surgery group (P<0.05). The cure rate was 100%.
 CONCLUSION The therapeutic methods based on patient's condition can improve the curative effect and prognosis in cornual pregnancy, which can keep the integrity of generative organs with less injury. The laparoscope might be a main therapeutic method for cornual pregnancy due to its safety, effectiveness, and minimal invasion.
Abortion, Induced ; Female ; Humans ; Laparoscopy ; Methotrexate ; therapeutic use ; Mifepristone ; therapeutic use ; Pregnancy ; Pregnancy, Cornual ; drug therapy ; surgery ; Retrospective Studies

Objective: First-line bevacizumab plus carboplatin and paclitaxel (CP) is approved for stage III/IV ovarian cancer treatment following initial surgical resection, based on global phase III GOG-0218 and ICON7 trials. This study evaluated the efficacy and safety of bevacizumab + CP as first-line ovarian cancer therapy in Chinese patients. Methods: Patients with newly diagnosed, International Federation of Gynecology and Obstetrics (FIGO) stage III/IV epithelial ovarian, fallopian tube, or primary peritoneal cancer post-primary surgery were randomized 1:1 to receive 6 cycles of CP with bevacizumab/ placebo, followed by bevacizumab/placebo maintenance until unacceptable toxicity or disease progression. Primary endpoint was investigator-assessed progression-free survival (PFS). Stratification factors were FIGO stage and debulking status (stage III optimally debulked vs stage III suboptimally debulked vs stage IV) and Eastern Cooperative Oncology Group performance status (0 vs 1 or 2). Results: Of randomized patients, 51 received bevacizumab + CP and 49 received placebo + CP. Median PFS was 22.6 months with bevacizumab + CP (95% confidence interval [CI]=18.6, not estimable) and 12.3 months (95% CI=9.5, 15.0) with placebo + CP (stratified hazard ratio=0.30; 95% CI=0.17, 0.53). Treatment-related grade 3/4 adverse events occurred in 46 of 49 (94%) patients receiving bevacizumab + CP, and 34 of 50 (68%) receiving placebo + CP. Conclusion Bevacizumab + CP showed clinically meaningful improvement in PFS vs placebo + CP, consistent with GOG-0218 results. Safety data were aligned with the known bevacizumab safety profile. These results support first-line bevacizumab + CP therapy in Chinese patients with ovarian cancer.

Objective: First-line bevacizumab plus carboplatin and paclitaxel (CP) is approved for stage III/IV ovarian cancer treatment following initial surgical resection, based on global phase III GOG-0218 and ICON7 trials. This study evaluated the efficacy and safety of bevacizumab + CP as first-line ovarian cancer therapy in Chinese patients. Methods: Patients with newly diagnosed, International Federation of Gynecology and Obstetrics (FIGO) stage III/IV epithelial ovarian, fallopian tube, or primary peritoneal cancer post-primary surgery were randomized 1:1 to receive 6 cycles of CP with bevacizumab/ placebo, followed by bevacizumab/placebo maintenance until unacceptable toxicity or disease progression. Primary endpoint was investigator-assessed progression-free survival (PFS). Stratification factors were FIGO stage and debulking status (stage III optimally debulked vs stage III suboptimally debulked vs stage IV) and Eastern Cooperative Oncology Group performance status (0 vs 1 or 2). Results: Of randomized patients, 51 received bevacizumab + CP and 49 received placebo + CP. Median PFS was 22.6 months with bevacizumab + CP (95% confidence interval [CI]=18.6, not estimable) and 12.3 months (95% CI=9.5, 15.0) with placebo + CP (stratified hazard ratio=0.30; 95% CI=0.17, 0.53). Treatment-related grade 3/4 adverse events occurred in 46 of 49 (94%) patients receiving bevacizumab + CP, and 34 of 50 (68%) receiving placebo + CP. Conclusion Bevacizumab + CP showed clinically meaningful improvement in PFS vs placebo + CP, consistent with GOG-0218 results. Safety data were aligned with the known bevacizumab safety profile. These results support first-line bevacizumab + CP therapy in Chinese patients with ovarian cancer.