Objective:To analyze the causes and influencing factors of conversion from laparoscopic surgery to laparotomy.Methods:To analyze and summarize the clinical data of 84 patients who converted to laparotomy in 16 203 cases of laparoscopic surgery from August 2017 to August 2020 in the Department of Gynecology of the Affiliated Hospital of Qingdao University, each patient converted to surgery was matched with 2 patients who underwent simple laparoscopic surgery. The patients were divided into conversion to laparotomy group (84 cases) and control group (168) cases, and analyze the influencing factors of laparoscopic conversion to laparotomy. χ 2 test or corrected χ 2 test or Fisher exact probability method were used for the comparison of counting data between groups, and conditional regression analysis was used for the multivariate analysis of case control design. Results:The conversion rate of gynecologic laparoscopic surgery to laparotomy was 0.52%(84/16 203). The reasons for 84 cases of conversion from laparoscopic surgery to open surgery were as follows: pelvic adhesion 50.0%(42/84), unexpected malignant tumor 19.0%(16/84), tumor oversize or special shape and location 14.3%(12/84), hemostasis difficulty 7.1%(6/84), multiple uterine fibroids 3.5%(3/84), simultaneous surgery 3.5%(3/84), bladder injury 1.2%(1/84), and subcutaneous emphysema 1.2%(1/84) during the operation. There were no significant differences in body mass index and comorbidities (diabetes, hypertension, coronary heart disease, thyroid disease) between the two groups (all P>0.05). And the history of endometriosis was 36.9% (31/84) and the history of pelvic surgery in the transperitoneal group was 60.7% (51/84) higher than that in the conversion to laparotomy group of 20.8% (35/84), 30.6% (51/84) (χ 2=7.482, 21.42, P=0.006). The results of conditional regression analysis showed that that surgical history( OR=3.979, 95% CI 2.010-7.874, P<0.001 and thyroid history ( OR=15.333, 95% CI 1.087-216.346, P=0.005) increased the risk of conversion to laparotomy; Hypertension history ( OR=0.203, 95% CI 0.067-0.622, P=0.005) reduced the risk of conversion to laparotomy. Further analysis of which operation type affected the conversion to laparotomy showed that cesarean section ( OR=2.105, 95% CI 1.109-4.351, P=0.044), myomectomy ( OR=11.605, 95% CI 3.306-40.735, P<0.001), and ovarian cyst removal ( OR=7.914, 95% CI 2.157-21.037, P=0.002) affected the conversion to laparotomy. Conclusion:The main reason for conversion from gynecologic laparoscopic surgery to laparotomy is pelvic adhesion. The history of surgery and thyroid disease are the risk factors for conversion to laparotomy. Among them, myomectomy and ovarian cyst removal are important factors for conversion to laparotomy. Before operation, appropriate clinical operation methods should be selected according to the patient's medical history and condition to ensure the patient's safety.

Objective: To explore the application and effect evaluation of the new teaching mode of medical nursing based on mobile teaching platform. Methods: Taking 110 nursing undergraduates from 2015 grade as the control group, 105 nursing undergraduates from 2016 grade were selected as the experimental group. On the basis of the traditional classroom teaching method, the "teaching online" mobile teaching platform was designed and constructed by using WeChat. At the same time, the instructors of internal science theory were invited to join the platform to simultaneously synchronize online teachers, teachers and students, and upload teaching resources. The final examination results of the two groups were compared, and the satisfaction of nursing undergraduates with the teaching of internal medicine nursing was investigated at the end of the semester, and the difference between the new teaching mode and the traditional teaching mode was demonstrated through a comparative study. At the same time, through questionnaires, we can understand the satisfaction of teachers and students in assisting teaching on mobile teaching platforms. Results: The teachers and students had a positive attitude towards the application of mobile teaching platform to assist teaching and platform functions. 6/7 of teachers and 94.3% (99/105) of students supported the promotion of this auxiliary teaching mode. All teachers and most students (92.4%, 97/105) evaluated the participation of teachers in internal medicine theory to improve the teaching effect. After the application of "teaching online" mobile teaching platform, the satisfaction of nursing undergraduates with internal medicine nursing teaching was obviously improved, the overall evaluation of teaching satisfaction in the control group and the experimental group were (4.00±0.42) and (4.83±0.42) points (t =-22.306, P<0.01). The average scores of the final exam in the experimental group (80.90±5.11) points was significantly higher than (74.86±7.37) points in the control group (t=-7.000, P<0.05). Conclusion The interdisciplinary joint teaching model based on mobile teaching platform can stimulate the students′ enthusiasm for learning and improve teaching satisfaction and learning effect.

To investigate the cellular target selectivity of small molecules targeting thioredoxin reductase 1, we reported the construction and functional research of a stable TrxR1 gene (encode thioredoxin reductase 1) knockout HCT-116 cell line. We designed and selected TrxR1 knockout sites according to the TrxR1 gene sequence and CRISPR/Cas9 target designing principles. SgRNA oligos based on the selected TrxR1 knockout sites were obtained. Next, we constructed knockout plasmid by cloning the sgRNA into the pCasCMV-Puro-U6 vector. After transfection of the plasmid into HCT-116 cells, TrxR1 knockout HCT-116 cells were selected using puromycin resistance. The TrxR1 knockout efficiency was identified and verified by DNA sequencing, immunoblotting, TRFS-green fluorescent probe, and cellular TrxR1 enzyme activity detection. Finally, the correlation between TrxR1 expression and cellular effects of drugs specifically targeting TrxR1 was investigated by CCK-8 assay. The results demonstrated that the knockout plasmid expressing the sgRNA effectively knocked-out TrxR1 gene within HCT-116 cells, and no expression of TrxR1 protein could be observed in stable TrxR1 knockout HCT-116 (HCT116-TrxR1-KO) cells. The TrxR1-targeting inhibitor auranofin did not show any inhibitory activity against either cellular TrxR1 enzyme activity or cell proliferation. Based on these results, we conclude that a stable TrxR1 gene knockout HCT-116 cell line was obtained through CRISPR/Cas9 techniques, which may facilitate investigating the role of TrxR1 in various diseases.
CRISPR-Cas Systems/genetics* ; Gene Editing ; Gene Knockout Techniques ; HCT116 Cells ; Humans ; RNA, Guide/metabolism*