Thanks to the policies of resources to strengthen grassroots ,and innovative resource placement in Zhejiang province and the help of Zhejiang University School of Medicine ,Shaoxing regional medical center has achieved significant improvement in its medical capabilities .The cooperation features the following :active promotion of new medical ideas and key technologies ;overall enhancement of scientific and technological innovation ;talent training to advance disciplinary development ;and joint efforts to train postgraduates .The momentum ,however ,can only be maintained ,unless such problems as the means of resources placement ,disciplines alignment ,and medical workers development can be well addressed .

Objective To explore the practicality and feasibility and evaluation of the team based learning method (TBL) combined with the clinical pathway leaning method (CP) in clinical teaching of department of gynecology and obstetrics. Methods Toltally 40 clinical specialist interns selected for the study were randomly divided into two groups (each 20) respectively, using TBL com-bined with CP teaching method and traditional teaching method, and to make analysis and comparisons on the above two teaching methods. Differences were compared with t testing. Meanwhile, a question-naire survey was carried out among students of TBL combined with CP teaching group for qualitative analysis of the implementation effect of TBL combined with CP pedagogy. (Qualitative analysis is the medical students' evaluation of teaching effect, without further statistical processing). Results The professional test results of TBL combined with CP teaching team were superior to the traditional teach-ing group [(83.95 ±7.63) vs. (72.00 ±5.26)] and the difference was significant by paired t tests and analysis (t=5.063,P<0.05). The knowledge contest results of TBL combined with CP teaching team were superior to the traditional teaching group(90 vs. 85,95 vs. 75,85 vs. 70). TBL combined with CP method has been recognized by 90% medical students and they think that most of their quality has been further improved. Conclusions TBL combined with CP method for the clinical teaching of de-partment of gynecology and obstetrics is practical and feasible, and should be widely applied.

Objective To evaluate whether the predictive value of admission hyperglycemia for mortality differs between diabetics and non-diabetics with acute coronary syndrome (ACS).Methods A total of 1534 consecutive patients admitted with ACS to Central Control Unit of Beijing Friendship Hospital were analyzed.Among these patients,1332 patients who had a venous plasma glucose record at admission were retrospectively enrolled and were stratified according to admission glucose levels with or without diabetes.The primary end point was in-hospital and 2-year all-cause mortality.Results In patients without a history of diabetes,649 patients had glucose level ≤7.8 mmol/L(group A),204 patients with 7.8-11.0 mmol/L (group B) and 142 patients ＞ 11.0 mmol/L (group C).Of those with diabetes,124 patients were in group A,142 in group B and 126 in group C.By Cox regression analysis,admission hyperglycemia (group B,HR 1.48,P =0.05 ; group C,HR 2.78,P ＜ 0.001) was an independent predictor of long-term all-cause mortality in patients without diabetes.In patients with diabetes,blood glucose ＞ 11.0 mmol/L (group C,HR 2.68,P ＜ 0.001) also independently predicted long-term all-cause mortality.Conclusions Compared with the diabetic patients,elevation of blood glucose at admission is common in ACS patients without definite history of diabetes.Admission hyperglycemia should be considered as a risk factor strongly correlated with in-hospital and 2-year all-cause mortality in patients with ACS.

Objective To depermine oupcome of papienps wiph non-ST elevapion acupe coronart stndromes (NSTEACS) preaped wiph FFR-guided versus CAG-guided sprapegt. Methods From Jult 1. 2014 po Jult 30. 2015 in Beijing Anzhen Hospipal, papienps admipped for NSTEACS were reprospecpivelt analtsed wiph a 10-monph follow-up. 142 cases on CAG were furpher assessed wiph FFR ( phe FFR group). Papienps were mapched as 1 : 2 wiph NSTEACS who had moderape lesions shown on CAG in phe same period were enrolled (CAG group, n = 284). End poinps were deaph, nonfapal mtocardial infarcpion (MI), pargep vessel revascularizapion ( TVR), and procedure cosps. Major adverse cardiac evenps ( MACE) were defined as deaph, nonfapal MI, and TVR. Results Fifpt-pwo papienps (36. 6% ) in phe FFR group had FFR less phan 0. 80 underwenp percupaneous coronart inpervenpion (PCI) while 133 papienps (46. 8% ) in phe CAG group received PCI (P =0. 037). Papienps preaped wiph FFR-guided sprapegt had significanplt lower rape of nonfapal MI (2. 2% vs. 4. 5% , P =0. 040) and TVR (5. 9% vs. 11. 7% , P = 0. 046). No spapispical difference was observed in morpalipt (0. 7% vs. 1. 1% , P = 0. 682) and MACE (8. 8% vs. 14. 4% , P = 0. 085). Topal financial cosp was less in phe FFR group (P = 0. 033). Conclusions FFR-guided sprapegt for papienps wiph NSTEACS resulps in less rape of PCI,lower cosp and bepper clinical oupcomes when compared wiph an angio-guided sprapegt.

Objective To evaluate the effects of applying clinical pathway (CP) in clinical teaching of gynecology and obstetrics. Methods Totally 200 clinical specialist interns selected for the study were randomly divided into two groups (each 100), respectively, using CP teaching and tradi-tional teaching. After the internship, professional assessment (clinical skills assessment, theory test, the respondent)were conducted to two groups of students and their professional examination scores were compared, while questionnaires were conducted in the CP teaching group. All date were analyzed by SPSS 17.0 software. Chi-square test was used for enumeration date while t test was used for mea-surement data. Results CP teaching team of professional test results [(80.01 ± 9.34) vs. (72.37 ± 10.79)], the passing rate(96%vs. 87%) were superior to the traditional teaching group(P=0.000 and 0.022). The questionnaire showed that: applying CP in clinical teaching of obstetrics and gynecology can improve interns' learning enthusiasm and initiative, improve their comprehensive analysis ability, clinical thinking ability, practical ability and many other capabilities and it got about 90% of interns' recognition. Conclusions The application of the CP in clinical teaching of obstetrics and gynecology can help enhance the teaching effectiveness, standardize the teaching process, and improve the qual-ity of teachers teaching gynecology and obstetrics.

Objective To investigate the association of excessive daytime sleepiness(EDS) and the quality of life in patients with moderate to severe obstructive sleep apnea and hypoventilation syndrome (OSAHS).Methods 123 patients with moderate to severe OSAHS were diagnosed by polysomnography(PSG),and 52 cases ruled out by PSG were controls.Patients and controls were completed the Calgary sleep apnea quality of life index (SAQLI) and the Epworth sleepiness score(ESS).Results There were statistical significance of body mass index (BMI),respiratory disturbance index(RDI),the lowest oxygen saturatioo( LSpO2 ),the longest apnea time( Tmax),the percentage of recording time with oxygen saturation of 90％ or less(T90) between the patients and the controls.Daily Functioning,Social Interactions,Emotional Functioning,Symptoms,and total scores of SAQLI in patients with moderate to severe OSAHS were(3.88 ± 1.05),(4.48 ± 1.39),(4.76 ± 1.59),(2.98 ± 1.10),(3.94 ± 1.22),which were less than that of controls respectively.The ESS scoree of patients with moderate to severe OSAHS were higher than that of controls[ ( 13.98 ± 4.05 ) vs (5.78 ± 2.45) ],( P ＜ 0.01 ).ESS were related to the daily Functioning,social interactions,emotional functioning,symptoms,and total scores of SAQLI in patients with moderate to severe OSAHS,and the coecient of correlation were - 0.52,- 0.48,- 0.40,- 0.48 and - 0.44,respectively,and all p value were less than 0.01.Conclusion Patients with moderate to severe OSAHS have the EDS,which associate with the impairment of quality of life.The higher ESS may indicate the decrease of quality of life in patients with moderate to severe OSAHS.

OBJECTIVE:To compare the efficacy and safety of methotrexate with different methods of administrations com-bined with hysteroscopy in the treatment of scar pregnancy(CSP). METHODS:Data of 56 CSP patients were retrospectively ana-lyzed and divided into group A(26 cases)and group B(30 cases)by different methods of administrations. The fluid in group A was injected methotrexate 50 mg/m2 into the capsule,once a week. After 1 week,if the β-HCG was decreased less than or equal to 50%,the patient was additionally injected methotrexate;and if the β-HCG was decreased more than 50%,no more methotrexate was given,the lesion electrosurgical excision was conducted under hysteroscopy when β-HCG<1 000 mU/ml. Group B was inject-ed methotrexate 50 mg/m2 into muscle,once a week. After 1 week,if β-HCG was decreased less than or equal to 50%,the patient was additionally injected methotrexate;and if the β-HCG was decreased more than 50%,no more methotrexate was given,the le-sion electrosurgical excision was conducted under hysteroscopy when β-HCG<1 000 mU/ml. The clinic data was observed,includ-ing success rate,β-HCG before and 4,7,10 and 14 d after treatment and the mass diameter of CSP before and 7 and 14 d after treatment in 2 groups. The incidence of adverse reactions was recorded. RESULTS:There were no significant differences in the suc-cess rate,mass diameter of CSP before and after treatment between 2 groups (P>0.05). After treatment,the β-HCG in 2 groups was significantly lower than before,14 d<10 d<7 d<4 d,and group A was lower than group B,the differences were statistically significant(P<0.05). The incidence of adverse reactions in group A was significantly lower than group B,the difference was statis-tically significant(P<0.05). CONCLUSIONS:Methotrexate with different methods of administrations combined with hysteroscopy has good efficacy in the treatment of CSP,however,the safety of intracapsular injection is better than intramuscular injection.

OBJECTIVE: To explore the role of IL-21 in the pathogenesis of myasthenia gravis (MG) and its influence on the the class switch of anti-AChR antibodies. METHODS: Blood was taken from 26 patients and 18 healthy controls, and the expression of IL-21R mRNA in peripheral blood mononuclear cells (PBMCs) was detected by RT-PCR. The expression of IL-21R on B lymphocytes was measured by flow cytometry, while the concentrations of serum IL-21 and the levels of anti-AChR-IgG and its isotype IgG(1), IgG(2), and IgG(3) were tested by ELISA. RESULTS: The serum concentration of IL-21 in the MG group was higher than that in the control group (31.686±8.499 pg/mL, 15.147±6.366 pg/mL) and the difference was significant (P<0.01). IL-21R mRNA expressed on PBMCs in the MG group was higher than that in the control group (0.139±0.052, 0.101±0.022), and the difference was significant (P<0.05). There was no difference between ocular MG and generalized MG subgroup (P>0.05). Compared with the control group, the expression of IL-21R on B lymphocytes also increased in the MG group (P<0.05). In the anti-AChR-Ab positive MG group, the serum concentration of IL-21 showed positive correlation with anti-AChR-IgG(P<0.05),but no correlation with its isotype IgG(1), IgG(2), and IgG(3), respectively(P>0.05). Expression of IL-21R mRNA in the PBMCs showed no correlation with the level of serum anti-AChR-IgG and its isotype IgG(1), IgG(2), and IgG(3), respectively(P>0.05); however the expression of IL-21R in B lymphocytes showed positive correlation with anti-AChR-IgG and it's isotype IgG(1) and IgG(3) (P<0.05,P<0.01,P<0.05), but no correlation with IgG(2) (P>0.05). CONCLUSION IL-21 might induce the class switch of anti-AChR antibodies to IgG(1) and IgG(3) isotype through IL-21R on B lymphocytes which promotes the pathogenesis of the MG.
Adolescent ; Adult ; Autoantibodies ; classification ; immunology ; Female ; Humans ; Immunoglobulin Class Switching ; immunology ; Immunoglobulin G ; classification ; Interleukins ; blood ; genetics ; Male ; Middle Aged ; Myasthenia Gravis ; blood ; immunology ; RNA, Messenger ; blood ; genetics ; Receptors, Cholinergic ; immunology ; Receptors, Interleukin-21 ; blood ; genetics ; Young Adult

This paper introduced the development of medical specialists alliance in Zhejiang University. With Jinhua Central Hospital as an example,merits and setbacks of the 3-level trusteeship model in practice were discussed,with improvement recommendations raised for progress of the hierarchical medical system.